Thursday AM 09-25-08

I talked to all the doctors this morning to get new insights into her health. I will approach this from their responibilities and specialties, presenting the facts and their views as I undertood them in our conversations.

Overall (attending physician)

She has a 65%-70% (corrected 9/26/08)chance of survival. She is ventilator and dialysis dependent. The Zestin antibiotics worked well to relieve her lungs from pneumonia. We no longer have that issue. Also, she has normal digestive system functions now. All her food is coming from a tube-fed liquid diet. That diet may need to be increased in volume but the dietician believes it has the right contents for mother's illnesses and condition. She is tolerating the liquid diet very well. Her skin lesions on the back are healing. The lesions on her left leg and buttocks continue to be about the same, perhaps slightly improved. The family will need to consider whether they want her to get a trachiostomy. I have not read up on this yet, but I am planning to read this article on it - John Hopkins University. It is something to start thinking about. The doctor said it would need to be done in two weeks, but the Pulmonary specialist said that is incorrect. His information is outdated. Two weeks used to require a change of the entry method but now with current technology applied, we can wait a couple of months. We don't know why her blood pressure is so low. The doctor will talk to the Cardiologist to see if another EKG could be acquired. Another cat scan is considered not neccessary. The EKG should tell us everything we need to know about any changes in the heart. Her arteries and circulation system elsewhere seems to be stable. She is not losing any significant blood. The blood on her mouth is not as bad as it looks but it is a "horrific" case of simplex that is being treated and getting better. Her diet is OK but may need more volume given to her. The dietition has reviewed the content of her tube feedings and she is getting sufficient calories for her condition. The doctor believes her skin requires more calories, thus the volume question. Her heart medicine for pressure is being given to her in low doses. When they started treating blood pressure they were giving it to her at a rate of 102- Mics. Now it is at 3 to 3.5 mics. She is on 30 mics propofol for a general sedative and pain reliever. She gets morphine for bandage changes. (I think dialysis is also included but not sure). A conference between doctors and family might be a good idea at this point.

Kidneys

Using same IV to perform dialysis as put on her on 9/12. She is producing no urine, so the kidneys are not functiong. There is a method to assess if the kidneys should we at sometime decide to pull support, that is to stop dialysis while she is dependent on it. It is called Nuclear Median Scan. It has no usefulness otherwise. It can tell how much the kidneys are damaged. Most patients in the ICU recover from situations like mother's. That does not mean she will recover her kidney functions but she has decent chance of that. Her prognosis is very poor, but we do not give her a zero chance of recovering her kidneys! If we thought that, a conference between families and doctors would be appropriate.

Lungs

She may have a condition known as ARDS. A web link for reference: ARDS. If so, there would not be any change in treatment. It is just academic to discuss this. It would be like beating her lungs and bruising them. The symptoms are there and the history of the patient indicates this is a feasible diagnosis (possibility raised by Dr McKellon). There is substantial water in her lung tissues but she is getting oxygenated quite well with the ventilator machine. Her blood acidity is about normal indicating that she is removing the CO2. The healing process is slow.

Heart

Not much discussion today. Dr McKennon indicated he would be requesting an EKG. Other than that, previous discussions still hold true. Her heart is pumping well. Dr McKennon said that the fluids are dispersing in her system from her heart abnormally because of the liquid content of her tissues. It is like going into a large cavity, so the low pressure is lower than normal.

Her stats for the day:
White blood count 15.5 (about the same), Red blood count 3.01, Hemoglobin 9.1, Hearbeat 72, O2 95, breathing rate 16, blood pressure 107/41 (56). Her lungs are getting 40% O2 under an air pressure of 25.